A qualitative study of quality of life and the experience of complementary and alternative medicine in Korean women with constipation

The effect of acupressure on constipation symptoms and quality of life among older people: a mixed-methods study

PURPOSE

This study aims to evaluate the effect of acupressure on constipation symptoms and quality of life in older people.

METHODS

The study was a double-blind, randomized, sham-controlled, qualitative and quantitative mixed-method study. Individuals in the acupressure group received acupressure for 21 min per day for a total of 12 sessions. The other group received sham acupressure for the same duration. Constipation Assessment Scale (CAS), Constipation Quality of Life Scale (PAC-QOL), Visual Analogue Scale (VAS) and individual follow-up form were used to evaluate quantitative data, and semi-structured interview form was used to evaluate qualitative data.

RESULTS

A total of 81 participants were randomized to acupressure (n = 41, mean age: 70.56 ± 4.76, 70.7% female) or sham acupressure (n = 40, mean age: 71.17 ± 5.19, 67.5% female). Repeated measurements of the participants showed that CAS scores differed significantly between acupressure applications (p < 0.001). There were also statistically significant differences between the two groups in PAC-QOL and VAS after the application, number of defecations and laxative use (p < 0.001). Compared to the placebo group, the acupressure group had significantly lower mean post-test scores in all constipation rating scales. Qualitative findings from the study also support the quantitative findings.

CONCLUSION

For older people seeking evidence-based alternative therapy, acupressure may be a solution to reduce the constipation symptoms. Future studies with larger sample sizes are needed to confirm our study findings.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05506397, 17 August 2022, retrospectively registered.

A Qualitative Study of the Experiences of Complementary and Alternative Medicine of Patients With IBS-C

The aim of this study was to examine the complementary and alternative medicine (CAM) experiences of patients with constipation irritable bowel syndrome (IBS-C). This qualitative study consisted of a total of 30 patients, who were admitted to a university hospital in Turkey. Data were collected using a descriptive questionnaire and a semistructured interview. Data analysis identified 5 main themes: (1) constipation-related difficulties experienced due to IBS, (2) the feeling that the CAM use is natural and useful, (3) the effect of the environmental stimuli in preferring the use of CAM, (4) the feeling that CAM is not negative and relieves, and (5) suggesting the CAM use. In conclusion, it was determined that all the patients with constipation IBS used various CAM methods. It may be recommended to raise the awareness of the patients by health care professionals about the CAM methods that may be useful.

A Qualitative Study of the Experiences of Complementary and Alternative Medicine Use in Patients With IBS-C

The aim of this study was to explore the experiences of complementary and alternative medicine (CAM) among patients with constipation irritable bowel syndrome (IBS-C). This qualitative study consisted of a total of 30 patients who were admitted to a university hospital in Turkey. Data were collected using a descriptive questionnaire and a semistructured interview. Data analysis identified 5 main themes: (1) the constipation-associated difficulties experienced because of IBS; (2) the feeling that CAM is natural and useful; (3) the effect of environmental stimuli in preferring the use of CAM; (4) the feeling that CAM is not negative and relieves symptoms; and (5) suggesting the use of CAM. In conclusion, it was determined that all the patients with IBS-C used various CAM methods. It may be recommended that health care professionals should raise awareness among patients about CAM methods that may be useful.

Efficacy and safety of Gelidium elegans intake on bowel symptoms in obese adults: A 12-week randomized double-blind placebo-controlled trial

BACKGROUND/AIMS

Gelidium elegans (GE) is known to have antiobesity effects and beneficial effects on functional bowel symptoms in preclinical studies. The aim of this study was to determine the efficacy and safety of GE intake on bowel symptoms in obese human adults.

METHODS

This 12-week single-center randomized double-blind placebo-controlled study was performed from September 2016 to May 2017. Consecutive obese subjects were randomly assigned (1:1) to either GE (1 g) or placebo (1 g) once daily group for 12 weeks. Patients' bowel symptoms were evaluated using the Bristol Stool Form Scale, Constipation Scoring System (CSS), and Patient Assessment of Constipation-Symptoms (PAC-SYM) questionnaire.

RESULTS

The stool symptom score of PAC-SYM significantly improved in the GE group compared with the placebo group after the 12-week treatment (P = .041). Abdominal discomfort score of CSS significantly decreased at 12 weeks compared to that at baseline in the GE group (P = .003), but not in the placebo group (P = .398). In addition, abdominal discomfort score of CSS slightly decreased in the GE group compared with the placebo group after the 12-week treatment (P = .060). However, stool consistency, total CSS score, and PAC-SYM score did not change significantly in both GE group and the placebo group over the 12-week treatment period.

CONCLUSIONS

GE treatment for 12 weeks improved the stool symptom score on the PAC-SYM and abdominal discomfort score on the CSS in obese adults. However, further research is needed in large-scale human studies.

The use of conventional and complementary health services and self-prescribed treatments amongst young women with constipation: An Australian national cohort study

BACKGROUND

Little research has been conducted regarding the comprehensive health service utilisation in constipation care. This study investigates the comprehensive health service utilisation amongst Australian women with constipation.

METHODS

This study draws upon data from the Australian Longitudinal Study on Women's Health. A total of 8074 young women were asked about their frequency of constipation, measures of quality of life, and use of a range of health services and self-prescribed treatments via two postal surveys conducted in 2006 and 2009, respectively.

RESULTS

The prevalence of constipation was 18.5% amongst women in 2009. Constipated women had poorer quality of health than women without constipation. Women who sought help for constipation were more likely to visit multiple groups of conventional and complementary health practitioners compared to women who did not experience constipation (p<0.005). However, women were less likely to visit a specialist for the management of constipation over time (2006 to 2009). There was an increase in the proportion of women with constipation who self-prescribed vitamins/minerals over time (p<0.001).

CONCLUSION

Although only 4.5% of women sought help for their constipation, given the increasing use of multiple health services across time, more studies are required regarding the optimal treatment in constipation care.

Complementary and alternative medicine use for constipation: a critical review focusing upon prevalence, type, cost, and users' profile, perception and motivations

OBJECTIVES

Complementary and alternative medicine (CAM) is increasingly used by those suffering from constipation. This paper reports the first critical integrative review of CAM use for people with constipation focusing upon the prevalence, type and cost of CAM use, as well as CAM users' profile, perception and motivations.

METHODS

A comprehensive search of international literature was conducted in MEDLINE, Academic Search Complete (EBSCO), and Allied and Complementary Medicine Database (AMED). The search was limited to original research peer-reviewed English language articles concerning CAM use for constipation published with an abstract and full text between 2005 and 2015.

RESULTS

A total of 35 papers met the inclusion criteria and were included in the review. The review shows approximately one in every three people suffering from constipation use CAM with herbal medicine the most commonly used CAM treatment for constipation and a large proportion of CAM use occurring concurrent with or in addition to conventional medical treatments. While early investigation suggests the cost of herbal medicine use in constipation care may be lower than that associated with the use other CAM modalities and conventional medications, this issue requires further research.

CONCLUSIONS

Although a high percentage of people with constipation using CAM consider these treatments effective, there remains a need for further in-depth examination of both patient and provider perspectives as well as communication and decision-making around CAM use for constipation to inform safe, effective and coordinated care for patients with constipation.

Effect of Polydextrose Intake on Constipation in Japanese Dialysis Patients: A Triple-Blind, Randomized, Controlled Trial

The objective of the present study was to evaluate bowel habits induced by ingestion of 10 g polydextrose (PDX) fed to Japanese hemodialysis (HD) patients. This was a randomized, placebo-controlled, triple-blind, parallel-group controlled, 8-wk study. A total of 50 HD outpatients capable of self-management (51-79 y of age) were recruited at H Clinic, Japan. Inclusion criteria for participation in the study were ingestion of one or more laxative tablets for more than 3 mo and having received HD for more than 6 mo. The participants were randomly assigned to 2 groups: A (0 g polydextrose/d; control), B (10 g polydextrose/d; PDX). The primary outcome measure was stool frequency. Secondary outcomes were stool consistency, abdominal pain, intestinal bloating and clinical biochemistry indexes. PDX had no significant effect on blood biochemistry indexes. The PDX group showed significant improvements in bowel function (stool frequency increased from 3.0 times per week to 7.5 times per week) and reported no laxation problems (abdominal distention, cramps, and diarrhea) (p<0.01). Regular consumption of the PDX products increased dietary fiber intake to recommended levels and improved bowel habits.

Constipation is casting a shadow over everyday life - a systematic review on older people's experience of living with constipation

AIMS AND OBJECTIVES

To explore and summarise best evidence of how constipation affects the daily living of older people from their own perspective. Furthermore, to assess how interventions aimed at treating constipation in older people affect patient-reported outcome such as quality of life.

BACKGROUND

Constipation is a common and overlooked problem with an impact on everyday life, especially among older people. Older people seem to have individual preconceptions on constipation which can influence the strategies used to prevent and treat constipation.

DESIGN

A systematic review, integrating findings from both qualitative and quantitative studies.

METHOD

Systematic searches were carried out in PubMed, CINAHL, PsycINFO and EMBASE on the 31st of July 2014. A search strategy was constructed with key concepts identified using PICO to identify quantitative studies and PIC(o) to identify qualitative studies. Search terms included constipation, elderly, aged, elderly people, aged people, quality of life, patient experience, patient perspective, meaning, emotion, psychological. Reference lists were searched manually.

RESULTS

A total of nine studies were included in the review, five quantitative and four qualitative. Three main themes crystallised from the results of the included studies: bodily experiences, everyday life shadowed by constipation and adverse psychological effects.

CONCLUSION

Constipation among older people was connected to subjective and comprehensive experiences. It had a negative impact on physical and mental well-being as well as the social life of older people. The review also showed that older people had individual and personal strategies, based on their own beliefs.

RELEVANCE TO CLINICAL PRACTICE

Healthcare professionals need to be aware of the experiences of living with constipation as well as the range of strategies used by patients to prevent and treat constipation. The patient perspective on constipation needs to be integrated in the strategies and actions carried out by healthcare professionals.

Living with constipation--older people's experiences and strategies with constipation before and during hospitalization

BACKGROUND

Constipation is a common problem among older people. This study aimed to explore how older patients experience constipation and which strategies they used in handling the condition before and during hospitalization.

METHODS

A qualitative exploratory research design was used. Fourteen semi-structured interviews were conducted with patients (61-91 years of age) during hospitalization. Data were analyzed by using content analysis.

RESULTS

Themes concerning experiences were Bodily signs and symptoms of constipation; the participants described severe pain during constipation, as well as pronounced relief after bowel movements, Impact on well-being and social activities; being constipated negatively impacted their mood and limited social activities, Striving for bowel balance; the participants experienced an ongoing strive for balancing between constipation and diarrhea. Themes related to strategies were Struggling to find a solution; they were aware of different strategies to prevent and treat constipation, though the most common solution described was the use of laxatives, Wait and see; the participants were awaiting to take action until they experienced constipation symptoms, Constipation is a private problem being challenged during hospitalization; constipation was considered a private issue rarely discussed with health-care professionals.

CONCLUSION

This study illuminates the need for health-care professionals to be attentive to this issue and initiate the conversation with patients in order to advise on the management of constipation.

Random control trial of hot compresses for women those who used laxatives on severity of constipation and quality of life

AIM

The purpose of this study was to determine the effectiveness of hot compresses for constipation and quality of life (QOL), with a focus on taking laxatives.

METHODS

Meeting the inclusion criteria were 60 women, who had taken over-the-counter laxatives for constipation. Sixty women were randomly assigned to either the intervention (n = 30) or control (n = 30) group. The study period was 4 weeks: the first 2 weeks (baseline) without intervention and the last 2 weeks (intervention) with heat stimulus using a commercially available thermic sheet (40°C). Women affixed the sheet to the lumbar area with the Jacoby line in the center immediately after waking and were instructed to remove the sheet after 5 h during the intervention period every day. During the intervention, women recorded their daily defecation and completed the Constipation Assessment Scale (CAS), Constipation QOL 15 (CQ), and 36 Item Short Form Survey.

RESULTS

The author excluded incomplete records and study protocol deviations; as a result, a total of 39 subjects (21 hot compresses group, 18 control group) was used for the analysis. Significant improvement was seen in days of defecation and the number of defecations per week for the intervention group. Significant improvement was also seen in physical and psychological subcategory of CQ15. No significant differences were found in the amount of laxatives used.

CONCLUSION

The lumbar application of a 40°C hot compresses in female adults with constipation improved their conditions of defecation and QOL, even though it did not reduce the amount of laxatives.

Epidemiology of constipation in São Paulo, Brazil: a population-based study

OBJECTIVE

Epidemiologic data on constipation in South America are limited. The main objective of this study was to assess the prevalence of self-reported symptoms of constipation in Brazil.

METHODS

Telephone and personal surveys were conducted among community-dwelling adults in homes with land-based telephones in São Paulo. Data were weighted by numbers of adults, total residents, and telephones in each household. To account for potential nonresponse and noncoverage bias, results were further adjusted according to Brazilian census data.

RESULTS

Among 4570 households contacted, 3050 adults (66.7%) participated. Respondents (mean [SE] age: 42.6 [2.7] years) were primarily women (53.1%). A minority of all respondents reported symptoms consistent with constipation, including a perception of incomplete voiding in 8.0%; expending efforts to defecate in 7.6%; ≤2 stools weekly in 9.0%; and hard stools in 12.7%. Prevalences of these symptoms and efforts to manage them were more frequent in women (P ≤ 0.004), but most were not significantly associated with advancing age. With increasing age, proportions of respondents with ≤2 stools per week declined (P = 0.001), whereas use of bowel enemas (P = 0.026) and digital maneuvers to disimpact stool increased (P < 0.001). Despite frequent constipation symptoms, the vast majority of respondents did not report using prescription medications, but some used natural remedies (29.5%) and/or laxatives (13.4%).

CONCLUSIONS

Symptoms of constipation are prevalent in São Paulo, particularly among women. On the other hand, most survey respondents did not use medications or other remedies that manage this condition. These findings may point to an unmet gastrointestinal treatment need. Future research is needed to corroborate our findings in rural settings and to further evaluate potential predictors and consequences of constipation in South America.

Health-related quality of life in dialysis patients with constipation: a cross-sectional study

OBJECTIVES

To evaluate differences in the health-related quality of life (HRQoL) between patients with constipation receiving hemodialysis (HD) and those receiving peritoneal dialysis (PD).

METHODS

In this cross-sectional study, 605 dialysis patients (478 HD cases and 127 PD cases; all patients were older than 18 years) from our hospital were included. A questionnaire was used to evaluate their constipation statuses. The effect of constipation on HRQoL was assessed, using the Chinese version of the 12-item short-form (SF-12) general health survey. Karnofsky score, sociodemographic, and clinical data were also collected. We performed multiple logistic regression analysis to define independent risk factors for constipation and impaired HRQoL.

RESULTS

A total of 605 participants (326 men [53.9%] and 279 women [46.1%]) were surveyed. The incidence of constipation was 71.7% in HD patients and 14.2% in PD patients. Dialysis patients with constipation had significantly lower mean SF-12 Physical Component Summary scale and Mental Component Summary scale scores than the nonconstipation group (P < 0.05), whereas HD patients had better SF-12 Physical Component Summary and Mental Component Summary scores than PD patients (P < 0.05). When we performed multivariate logistic regression analysis, dialysis modality, diabetes, and the number of constipation-related medications were three independent risk factors associated with constipation. As for impaired HRQoL in the constipated dialysis population, dialysis modality was found to be another independent risk factor in addition to age and diabetes.

CONCLUSION

PD patients with constipation had worse HRQoL than HD control participants. We should pay more attention to the patients with constipation receiving PD, as peritonitis caused by constipation was associated with a higher mortality.

Acupuncturist perceptions of serving as a clinical trial practitioner

OBJECTIVE

This article describes the experience of four acupuncturists in terms of what it meant for them to be a practitioner in a recently completed sham-controlled acupuncture randomized control trial (RCT) with a standardized protocol.

DESIGN

At the completion of the RCT for women with ovarian dysfunction, study acupuncturists (2 male MD/acupuncturists and 2 female professional acupuncturists) were queried about their perceptions of participating in the RCT using both written responses to 5 open-ended questions and a focus group interview. Data was analyzed to categorize responses and identify themes.

SETTING

Virginia, USA.

RESULTS

The acupuncturists' experience of participating in a RCT was generally very positive, including: usual practitioner/participant relationships, collegial sharing, and increased patient volume and diversity. There was angst expressed about the unknown RCT results. While there were concerns about standardizing the acupuncture session ("dilutes the power of acupuncture therapeutics"), the acupuncturists' were supportive of the pre-established protocol. The acupuncturists overall did not have concerns with a sham intervention arm because the sham recipients did not know their treatment arm and felt as satisfied with study participation as the true acupuncture recipients.

CONCLUSIONS

Despite initial misgivings about both a standardized protocol and a sham arm, all practitioners discovered positive aspects of being a study acupuncturist. The analysis highlights the need for communication before, during and after a clinical trial between the study investigators and the intervention practitioners. As stake holders in the perception of CAM therapies with the public and with conventional medicine practitioners, it would benefit future research on CAM to similarly assess experiences of being a CAM study practitioner in order to enhance provider recruitment and reduce provider drop-out.